Care of the Dying Patient

F’RArT!CP GIimFuNF TITLE: Care of the Dying Patient
TARGET AUDIENCE

ACU
AUSTRALIAN CATHOLIC UNIVERSITY
This guideline is intended for clinical staff, particularly medical and nursing staff, involved in the care of dying patients on the wards and in the critical care areas of the hospital such as the ICU and ETC.
PURPOSE
The purpose of this document is to provide guidance for clinical staff in providing care to patients who are in their final hours or days, when death is expected. This guideline is designed to improve the care provided to dying patients on the wards by prompting consideration of important aspects of their management. This includes symptom control, reduction of unwarranted interventions and communication with the patient and their family.
GUIDELINE
The ultimate goal is to maintain the patient’s dignity and comfort at all times. It is important to regularly observe and monitor patients to achieve good symptom control. The Care of the Dying Patient Plan — Symptom Observation Chart (SOC) is used to record these symptoms (Appendix 2). The SOC should be commenced once the medical team have identified that this patient is imminently dying and the Care of the Dying Patient Plan (CDPP) — Medical form has been completed (Appendix 1). Nursing staff should confirm with the medical team that there is no longer a need to record vital signs and that appropriate Goals of Care have been documented for the patient. Any available advance care planning documents should be accessed and reviewed when caring for the dying patient. Symptom Observation Chart (SOC) Appendix 2 A full set of observations must be recorded at least 4 hourly. Each set of observations must be correctly timed, dated and documented in black/blue ink. Symptom observations should include (but not be limited to);
• Pain • Restlessness and agitation • Breathlessness (dyspnoea) • Secretions (gurgly breathing) • Nausea and vomiting • Involuntary jerking (myoclonus) Symptoms should be rated according to absent, mild, moderate or severe. The rating is based on the patient’s reporting and/or the nurse’s clinical assessment of the patient.
Additional observations/comments should include:
• Voided • Bowels open • Repositioning • Mouth care • PRN medications provided The escalation guidelines should be used to determine the action to take if symptoms are present. Evidence of this escalation should be documented in the escalation row on the SOC and the action taken documented in the clinician comments section.
The SOC should be discussed /shared with the patient and/or those closest to the patient as appropriate. Relevant family/carer information can be recorded in the appropriate box on the SOC.
Document nursing care in patient’s notes once per shift, ensuring all goals of comfort care are met.